vitamin c infusion for treatment in sepsis induced acute lung injury

Conditions: Acute Lung Injury; Sepsis

Summary: hypothesis 1a: vitamin c infusion will significantly attenuate sepsis-induced systemic organ failure as measured by sequential organ failure assessment (sofa) score, hypothesis 1b: vitamin c infusion will attenuate sepsis-induced lung injury as assessed by the oxygenation index and the ve40 hypothesis 1c: vitamin c infusion will attenuate biomarkers of inflammation (c-reactive protein, procalcitonin), vascular injury (thrombomodulin, angiopoietin-2), alveolar epithelial injury (receptor for advanced glycation products), while inducing the onset of a fibrinolytic state (tissue factor pathway inhibitor).


Eligibility criteria:
inclusion criteria: * patients must have suspected or proven infection, and meet 2 out of 4 of the criteria for systemic inflammatory response (sirs) due to infection, and be accompanied by at least 1 criterion for sepsis-induced organ dysfunction, and meet all 5 criteria for acute respiratory distress syndrome (ards). * suspected or proven infection: (e.g., thorax, urinary tract, abdomen, skin, sinuses, central venous catheters, and central nervous system, see appendix a). * the presence of a systemic inflammatory response: defined as: fever: \>38ºc (any route) or hypothermia: \ 90 beats/min or receiving medications that slow heart rate or paced rhythm, leukocytosis: \>12,000 wbc/µl or leukopenia: \ 10% band forms. respiratory rate \> 20 breaths per minute or paco2 \< 32 or invasive mechanical ventilation. * the presence of sepsis associated organ dysfunction: (any of the following thought to be due to infection) * sepsis associated hypotension (systolic blood pressure (sbp) \ 40 mm hg unexplained by other causes or use of vasopressors for blood pressure support (epinephrine, norepinephrine, dopamine =/\> 5mcg, phenylephrine, vasopressin) * arterial hypoxemia (pao2/fio2 \ 6lpm. * lactate \> upper limits of normal laboratory results * urine output \ two hours despite adequate fluid resuscitation * platelet count \< 100,000 per mcl * coagulopathy (inr \> 1.5) * bilirubin \> 2 mg/dl * glasgow coma scale \< 11 or a positive cam icu score * ards characterized by all the following criteria * lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms * bilateral opacities on chest imaging not explained by other pulmonary pathology (e.g. pleural effusions, lung collapse, or nodules) * respiratory failure not explained by heart failure or volume overload * decreased arterial pao2/fio2 ratio ≤ 300 mm hg * minimum peep of 5 cmh2o (may be delivered noninvasively with cpap to diagnose mild ards exclusion criteria: * known allergy to vitamin c * inability to obtain consent; * age \< 18 years; * no indwelling venous or arterial catheter in patients requiring insulin in a manner that requires glucose being checked more than twice daily (e.g. continuous infusion, sliding scale); * presence of diabetic ketoacidosis; * more than 48 hrs since meeting ards criteria; * patient or surrogate or physician not committed to full support (not excluded if patient would receive all supportive care except for cardiac resuscitation); * pregnancy or breast feeding, * moribund patient not expected to survive 24 hours; * home mechanical ventilation (via tracheotomy or noninvasive) except for cpap/bipap used only for sleep-disordered breathing; * home o2 \> 2lpm, except for with cpap/bipap * diffuse alveolar hemorrhage (vasculitis); * interstitial lung disease requiring continuous home oxygen therapy; * active kidney stone * non english speaking; * ward of the state (inmate, other)